PURVOTTAR VISWAVIDYAPEETH

(Established as per Assam Private University Establish and Regulation Act 2007 and u/s 2(f)
of UGC Act 1956)
Khutabari- 783123, Assam

Study Centre Application Form

Please fill up this form and attach supporting documents.

1. Name of the Applicant /Trust/ Society / Registered Institution: (Please attach

Deed/Document)

2. Registration Number and State where Registered:

3. Address with Pin code:

a) Postal Address:

City: Pin Code:

b) Email Address:

c) Website, if any, then URL:

4. Telephone Nos with STD Code:

a. O -

b. R -

c. Mobile -

d. FAX -

5. Name of the Institution under the Society / Trust where Training will be imparted:

6 Address with Pin code:-

a. Postal Address:

City: Pin Code:

b. Email Address:
 c. Website URL (if applicable):

7. Telephone Nos with STD Code:

a) O -

b)R -

c)Mobile -

d)FAX -

8. Name of the Head of Institution: (Provide detailed information, as per Annexure - B)

9. Work Experience of Management: (Attach details in Annexure - B)

10.Assessment of the Center with respect to location:

a. Location Prime / on Road etc.

b. Commercial / Residential
c. Owned/ On Lease / Rent etc.
(Attach Lease/Rent Deed)

d. Visibility from Road & Parking space.

e. Familiarity of the location
12. Total carpet area (Please attach the layout plan) :

13. Infrastructure of Center

a. No. of Class Rooms :

b. Seating capacity with furniture :

c. No. of Class Rooms :

d. Total no. of students who can be trained at a time :

e. Air conditioning :

f. Training Aids such as overhead projectors / boards :

g. Computer / TV / VCR based classroom :

h. UPS for computer System :

i. No. of Counseling Rooms :

j. Conference / Meeting room :

k. No. of Computer Labs :

l. No. of computers in each lab and total no. of computers :

m. Configuration of Computers (Attach configuration details) :

n. Softwares used and their source (Attach software details):

o. Any specialized multimedia lab with

 CD-ROM/Speakers/Headphones :

p. Educational CD available :

q. Networking in lab and its type (UTP/OFC/ETC) : Specify

r. Internet Connection & Type : Specify

s. No. of Modems :

t. Number of printers :

u. Staff room and other facilities provided to staff :

v. Generator for Power backup :

14. Faculty/Lab Assistants/Support Staff *:

(Provide name, qualification, experience and date of joining – detailed resume of

each faculty member to be attached to the application)

a) Center Manager / Center Head / Technical Head:

b) System Administrator:

c) Web Administrator:

d) Network Administrator:
e) Senior Faculty Members:

f) Junior Faculty Members:

g) Lab Assistants:

h) Clerical staff:
 i) Counselors:

j) Any other Supporting Staff:

15. Library (Attach List of Books) :-

a. No. of books in Library* :

b. No. of Newspapers/Periodicals/Magazines :

c. No. of Technical and Non Technical book :

d. Library seating capacity (No. of students who

can be accommodated at a time) :

e. No. of librarians :

f. Annual budget for library (Average) :

16. Any collaboration / proposed collaboration with any other university/Institution for
IT or any other programs:
 a. Name of the University/Institution:

b. University Address:

c. Programs being undertaken:

I. Diploma :
II.Undergraduate :
III.Post Graduate :
IV.Any other Program :

17. Please fill in the Actual details of your existing set – up

All Coordinator are hereby advised to strictly adhere to above mentioned

guidelines, failing which they will be delisted as Coordinator
 DECLARATION

1. I/We agree that we make advertisement from our side and we will not charge any
amount for any kind of advertisement from Viswavidyapeeth.

2. I/ WeCertify that we will abide by all decisions taken by Viswvidyapeeth Learning from
time to time which are related to the programs such as conduct of programs and
procedures to be followed.

3. I/We undertake to verify and certify that students registered for University programs are
eligible in all respect as per the eligibility condition laid and will arrange to produce all
original certificate / documents to prove their eligibility as and when required.

4. I/We hereby undertake, if selected to start the Centre within the stipulated time period as
maybe defined by Viswvidyapeeth from time to time from the date of Approval of this
application, failing which I/We agree to the rejection of this application.

5. I/We certify that all information in this application form and on any attachments is true
and accurately represents my/our current and continuing financial conditions. I/We
authorize Viswavidyapeeth to verify any information from whatever source it deems
appropriate. I/We understand that any misrepresentation in this statement may result in
rejection of this application.

I/We have fully satisfy myself about the legal status of the Viswvidyapeeth i.e. it is an
autonomous statutory body with regulations making power for it’s functioning.
Viswavidyapeeth is duly authorized and competent to provide me/us Study centre for
conducting the course for which I/we have applied. I/We also undertake not to ever
raise any objection about Viswvidyapeeth’s legal status to take anybody’s admission
and award degrees on qualifying prescribed examinations. I/We also undertake not to
demand refund of fees/charges paid by me or by the students already admitted. In
case of any dispute/differences/claim or disciplinary action settlement by
Viswvidyapeeth arbitration clause shall be applicable.

I shall always follow the rules and regulations of the Viswvidyapeeth and in case of
my breach thereto, I shall be liable to be penalized for the same which may include
expulsion from the Viswvidyapeeth

(Name of applicant) (Signature) (Date)

• Enclose A Demand Draft of Rs. 10,000/- (ten thousand) as study centre fees to be
made in favour of “Sree Sankara College” payable at Guwahati. (Draft No………………
…………………… Date………………………………………. Bank……………………………………
…………..